Oesophageal Carcinoma (16)

Question 1

What is the normal esophagus lining?

Answer 1

Non keratinized stratified squamous epithelium

Question 2

What is the effect of prolonged GERD?

Answer 2

Chronic GERD leads to the development of Barret’s esophagus with increased risk of developing adenocarcinoma

Question 3

A smoker patient with dysphagia and history of GERD and weight loss of 20 pounds.

What is the most probable diagnosis?

Answer 3

Cancer esophagus

Question 4

A smoker patient with dysphagia and history of GERD and weight loss of 20 pounds.

What are the etiological factors of cancer esophagus in this patient?

Answer 4

• Chronic GERD
• Smoking

Question 5

A smoker patient with dysphagia and history of GERD and weight loss of 20 pounds.

Which test is recommended for this patient?

Answer 5

Endoscopy plus EUS with FNAC

Question 6

What can the obtained cells from EUS with FNAC from oesophagus tumour cells tell you?

Answer 6

• Stage
• Grade
• Immunohistochemistry

Question 7

What is the stain used in immunohistochemistry for EUS with FNAC in cells for oesophageal cancer?

Answer 7

Cytokeratin

Question 8

A smoker patient with dysphagia and history of GERD and weight loss of 20 pounds.

Pathology report showed Barret’s esophagus Columnar metaplasia of the stratified squamous epithelium of the esophagus Type of lining: columnar epithelium Type of cancer: adenocarcinoma. Staging: TNM [T2, N1]

What are the possible causes of pleural effusion if the patient develops it?

Answer 8

• Spread of cancer cells to pleura (malignant pleural effusion)
• Lung metastases
• Obstruction of the thoracic duct
• Pulmonary embolism

Question 9

What pathological test should be done in oesophageal cancer patient with pleural effusion?

Answer 9

Effusion cytology

Question 10

How should a patient with maligant pleural effusion be treated?

Answer 10

• Palliative treatments
  
  • Thoracentesis
  • Indwelling pleural catheters (IPCs)
  • Pleurodesis
  • Pleuroperitoneal shunting (PPS)

Question 11

What investigation should be done if there is an enlargement of a supraclavicular lymph node?

Answer 11

FNAC

Plus consideration of CT a/p

Question 12

What are the features under the microscope for metastatic adenocarcinoma?

Answer 12

Tumor cells with hyperchromatic eccentric nuclei and intracytoplasmic vacuolation

Question 13

What are the investigations for MI?

Answer 13

• ECG
• Troponin
• CK-MB

Question 14

What is troponin?

Answer 14

A complex of three regulatory proteins (troponin C, troponin I, and troponin T) that is integral to muscle contraction

Question 15

Where is troponin found?

Answer 15

Cardiac muscle (myocardium) and skeletal muscle

Question 16

TNM Staging and Histologic grade for oesophageal cancer

Answer 16

T status
- Tis High-grade dysplasia
- T1 Invasion into the lamina propria, muscularis mucosae, or submucosa
- T2 Invasion into muscularis propria
- T3 Invasion into adventitia
- T4a Invades resectable adjacent structures (pleura, pericardium, diaphragm)
- T4b Invades unresectable adjacent structures (aorta, vertebral body, trachea)

N status
- N0 No regional lymph node metastases
- N1 1 to 2 positive regional lymph nodes
- N2 3 to 6 positive regional lymph nodes
- N3 7 or more positive regional lymph nodes

M status
- M0 No distant metastases
- M1 Distant metastases
- Histologic grade
- G1 Well differentiated
- G2 Moderately differentiated
- G3 Poorly differentiated
- G4 Undifferentiated